Glycemic Characteristics and Clinical Outcomes of COVID-19 Patients Hospitalized in the United States
Glycemic Characteristics and Clinical Outcomes of COVID-19 Patients Hospitalized in the United States
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DOI：
10.1177/1932296820924469
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发表时间：
2020-07-01
影响因子：
5
通讯作者：
Klonoff, David C.
中科院分区：
文献类型：
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作者：
Bode, Bruce;Garrett, Valerie;Klonoff, David C.
糖尿病已成为COVID-19导致严重疾病和死亡的重要风险因素。目前关于住院COVID-19糖尿病和急性高血糖患者血糖控制的信息很少。方法：这项对实验室确诊的COVID-19成人的回顾性观察性研究评估了2020年3月1日至4月6日住院的糖尿病和/或急性不受控制的高血糖患者的血糖和临床结局。糖尿病定义为A1 C ≥ 6.5%。不受控制的高血糖症定义为在任何24小时内>= 2次血糖（BG）> 180 mg/dL。数据提取自Glytec的数据warehousing.Results：在88家美国医院的1122名患者中，451名糖尿病和/或未控制的高血糖患者的平均血糖> 180 mg/dL的患者天数占37.8%。在570例死亡或出院的患者中，184例糖尿病和/或未控制的高血糖患者的死亡率为28.8%，而386例无糖尿病或高血糖患者的死亡率为6.2%（P <0.001）。在184例死亡或出院的糖尿病和/或高血糖患者中，96例未控制的高血糖患者中有40例（41.7%）死亡，而88例糖尿病患者中有13例（14.8%，P <0.001）。在493名出院幸存者中，184名糖尿病和/或未控制的高血糖患者的中位住院时间（LOS）长于386名无糖尿病或高血糖患者（5.7 vs 4.3 d，P < .001）。这些患有糖尿病和/或不受控制的高血糖症的COVID-19患者的LOS较长，死亡率明显高于未患糖尿病或不受控制的高血糖症的患者。血糖不受控制的患者死亡率特别高。我们建议卫生系统确保住院高血糖症得到安全有效的治疗。
Introduction: Diabetes has emerged as an important risk factor for severe illness and death from COVID-19. There is a paucity of information on glycemic control among hospitalized COVID-19 patients with diabetes and acute hyperglycemia.Methods: This retrospective observational study of laboratory-confirmed COVID-19 adults evaluated glycemic and clinical outcomes in patients with and without diabetes and/or acutely uncontrolled hyperglycemia hospitalized March 1 to April 6, 2020. Diabetes was defined as A1C >= 6.5%. Uncontrolled hyperglycemia was defined as >= 2 blood glucoses (BGs) > 180 mg/dL within any 24-hour period. Data were abstracted from Glytec's data warehouse.Results: Among 1122 patients in 88 U.S. hospitals, 451 patients with diabetes and/or uncontrolled hyperglycemia spent 37.8% of patient days having a mean BG > 180 mg/dL. Among 570 patients who died or were discharged, the mortality rate was 28.8% in 184 diabetes and/or uncontrolled hyperglycemia patients, compared with 6.2% of 386 patients without diabetes or hyperglycemia (P < .001). Among the 184 patients with diabetes and/or hyperglycemia who died or were discharged, 40 of 96 uncontrolled hyperglycemia patients (41.7%) died compared with 13 of 88 patients with diabetes (14.8%, P < .001). Among 493 discharged survivors, median length of stay (LOS) was longer in 184 patients with diabetes and/or uncontrolled hyperglycemia compared with 386 patients without diabetes or hyperglycemia (5.7 vs 4.3 days, P < .001).Conclusion: Among hospitalized patients with COVID-19, diabetes and/or uncontrolled hyperglycemia occurred frequently. These COVID-19 patients with diabetes and/or uncontrolled hyperglycemia had a longer LOS and markedly higher mortality than patients without diabetes or uncontrolled hyperglycemia. Patients with uncontrolled hyperglycemia had a particularly high mortality rate. We recommend health systems which ensure that inpatient hyperglycemia is safely and effectively treated.